tbuckley/cabot-search huggingface dataset:
Abstract P626: Associations of Supervised and Home-Based Exercise With Serious Adverse Event Rates During Exercise Interventions for Peripheral Artery Disease: A Meta-Analysis of Five Randomized Clinical Trials
Authors: Neela Thangada, Shujun Xu, Lu Tian, Lihui Zhao, Mary M McDermott
Journal: Circulation (2023)

Background: Supervised or home-based walking exercise therapy (ET) are guideline recommended to improve walking performance in people with peripheral artery disease (PAD). This study compared serious adverse event (SAE) rates associated with home-based compared to supervised exercise in people randomized into clinical trials of ET for PAD. Methods: Data from five randomized clinical trials of ET for PAD were combined. In three trials (GOALS, HONOR, and LITE), participants were randomized to home-based ET or control. In two trials (PROPEL and TELEX), participants were randomized to supervised ET or control. The primary outcome in all trials was change in six-minute walk. SAEs consisted of hospitalization or death and were identified from participants, family members, and medical records. In post-hoc analyses, a meta-analysis compared associations of supervised ET and home-based ET on odds of a SAE or death. Control groups from the trials of supervised and home-based ET were not combined. Results: 867 unique participants were included (mean age + SD: 69 ±10 years, 47% female, 57 % Black, mean + SD ABI 0.66 ±0.15). Results are shown in the Table. Conclusion: In clinical trials of home-based ET, rates of coronary revascularizations and cardiovascular events were significantly higher in participants randomized to exercise, compared to control. However, there were no significant differences in rates of coronary revascularizations or cardiovascular events between participants randomized to home-based, compared to supervised ET. Improved walking performance from home-based exercise may precipitate symptoms from underlying coronary artery disease in people with PAD.
Abstract P526: Associations of Body Mass Index Variability From Childhood and Midlife Class II and Class III Obesity
Authors: Soo Jung Kang, Ileana De Anda-Duran, Shirine Moukaled, Camilo Fernandez, Lydia A Bazzano
Journal: Circulation (2023)

Background: Short periods of weight loss followed by weight gain (BMI variability) has been linked to adverse cardiovascular outcomes in adults. However, less is known about the effect of long-term BMI variability from childhood on midlife class II and class III obesity. We identified this effect in a cohort of Black and White midlife adults living in a rural community. Methods: We studied 1,268 midlife participants of the Bogalusa Heart Study (age at baseline 9.5 ± 3.5 years, age at midlife 48.2 ± 5.2 years, 59.5% women, 34.4% Black) with ≥4 measurements of BMI and other traditional cardiovascular risk factors (CVRF) from childhood. Long-term BMI variability was computed as deviation from age-predicted values (DEV). Logistic regression, adjusting for age, sex, race, CVRF, depression, alcohol use, education, and employment status, was conducted to assess associations between long-term BMI variability and midlife obesity (class II and III, BMI ≥35kg/m 2 and ≥40kg/m 2 , respectively). Interactions between race, sex and long-term BMI variability were assessed. Results: Prevalence of midlife class II and class III obesity were 26.81%(n=340) and 12.7%(n=161), respectively. DEV was positively significantly associated with having midlife class II and class III obesity. For class II obesity, no significant interactions between DEV and race or sex were observed. For class III obesity, interactions of DEV with race and sex were significant; the odds of having class III midlife obesity per unit increase in DEV were greater in White participants and in men compared with Black participants and women(see Table 1). Conclusions: We identified associations between long-term BMI variability from childhood and midlife obesity. Race and sex were observed to modify the effect of BMI variability on having midlife obesity. Further studies are needed to elucidate the role of long-term BMI variability as a predictor for increased risk of midlife obesity.
Abstract P615: Frequency of Herb and Spice Use Among the South-Asian Adult Population in the United States: A Pilot Study
Authors: Samantha Harris, Bridget Hussain, Sarika Dasraj, Andrew Ashley, Aleksandra Kiszka, Twesha Khanna, Sameera Talegawkar, Rupak Shivakoti, Niyati Parekh
Journal: Circulation (2023)

Introduction: South Asians (SA) are among the fastest growing immigrant population in the U.S. They are at higher risk for atherosclerotic cardiovascular disease (ASCVD) and cardiovascular diseases (CVD) compared to non-Hispanic whites and East-Asians. Dietary components are modifiable risk factors for various non communicable diseases. SA Adults incorporate a unique set of herbs and spices in their cooking. The American Heart Association (AHA) directly recommends limiting salt intake, yet neglects to include recommendations about herb and spice use. Our objective was to collect information about SA herb and spice use that can be incorporated in the development of a diet assessment tool that encompasses traditional and western dietary practices among SA Americans. Hypothesis: We assessed the hypothesis that SA Adults living in the United States will report frequent (4+ times/week) use of herbs and spices in their cooking. Methods: A sample of adults aged 18+ yrs, self-identifying as SA and living in the U.S. were recruited via email, flyers, and social media platforms. Sociodemographic information and food preparation habits were collected using a Qualtrics survey. Respondents (n=29) were invited to participate in focus groups (n=16) via zoom. Participants were queried on meal habits, food list groupings [including 73 herbs and spices] and frequency of herb and spice use. Results: The Qualtrics survey (n= 13, 44.8%) and focus group (n=14, 87.5%) responses showed a high frequency of herb and spice use (&gt;4 times/week). Participants reported intentionally reducing salt and fat intakes in their diets, and increasing herbs and spice use for health reasons (n=8, 50%). Many (n=8,50%) commented that food did not taste like “home” , but they wanted to prioritize health. Additionally, use of pre-made/packaged spice mixes was reported by all participants in the focus group (n=16, 100%). The ten most frequently consumed herbs and spices were: garlic, black pepper, salt, turmeric, ginger, cumin, onion, coriander, chili powder and fenugreek. Conclusions: This study demonstrates that SA Adults living in the US frequently consume a varied number of herbs and spices. This finding underlies the need for developing a culturally component diet assessment tool, for example one that includes herbs and species for SA, to assess their relationship to CVD. In conclusion, this study demonstrates the necessity of dietary recommendations that align with cultural practices.
Abstract P349: Predictive Value of Long-Term Systolic Blood Pressure Variability for the Development of Type 2 Diabetes Mellitus
Authors: Hiroshi Yatsuya, Zean Song, Young-Jae Hong, Razib Mamun, Yuko Yoshida, Tahmina Akter, Gabriel Nuamah, Rina Tajima, Jingyi Lin, Abubakr Al-shoaibi, Chifa Chiang, Yoshihisa Nakano, Yuanying Li, Masaaki Matsunaga, Atsuhiko Ota, Koji Tamakoshi
Journal: Circulation (2023)

Background: Better identification of high-risk individuals of type 2 diabetes mellitus (T2DM) for focused delivery of preventive measures requires risk prediction models using novel predictors. We evaluated the predictive value of long-term variability of systolic blood pressure (SBPV), which was recently reported to be associated with T2DM incidence, if added to a model with conventional T2DM predictors in a Japanese cohort study. Methods: A cohort of 3017 Japanese individuals (2446 male, 571 female) ages 36-65 years were followed from 2007 to 2019. Root-mean-square error (RMSE) and slope of systolic blood pressure (SBP) change regressed on year were calculated per individual using SBP values obtained consecutively from 2003 to 2007 to represent SBPV. An initial Cox model included age, sex, smoking status, regular exercise, family history of diabetes, body mass index (BMI), baseline SBP, blood levels of triglycerides (TG), high-density lipoprotein cholesterol (HDLC) and fasting blood glucose (FBG), and backward elimination was used for variable selection. The c-statistics, net reclassification improvement (NRI) and integrated discrimination improvement (IDI) were used to compare the performance of prediction models without (Model 1) and with SBPV (Model 2). Results: During 9.8-year (median) follow-up, 135 developed T2DM. We confirmed that RMSE was significantly associated with T2DM incidence independent of other variables used in a conventional model. Backwards elimination procedure selected BMI, TG, HDLC, FBG, SBP RMSE, and SBP slope for the final model (Table 1). Although the c-indices were not statistically different between Model 1 (0.77) and Model 2 (0.78) as well as the NRI (7.1%), the IDI was statistically significant (0.8%, p&lt;0.05). Conclusions: The present study revealed that long-term variability of SBP slightly improved the predictive value of T2DM if added to a conventional prediction model.
Abstract MP01: Midlife Diabetes and Lifetime Risk of Dementia: During 30 Years Follow-Up From the ARIC Study
Authors: Jiaqi Hu, Michael Fang, James R Pike, Pamela L Lutsey, A. R Sharrett, Lynne E Wagenknecht, Timothy M Hughes, Jesse Seegmiller, Rebecca F Gottesman, Thomas Mosley, Elizabeth Selvin, Josef Coresh
Journal: Circulation (2023)

Introduction: Diabetes is associated with both dementia and death. Ignoring the competing risk of mortality may result in overestimation of the lifetime of dementia. Hypothesis: The lifetime cumulative incidence of dementia associated with diabetes will be much lower when taking into account the competing risk of mortality, particularly at the oldest ages. Methods: We conducted a prospective cohort analysis of data from the Atherosclerosis Risk in Communities (ARIC) Study (midlife baseline at visit 2, 1990-1992). Diabetes was defined as a self-reported physician diagnosis, diabetes medication use, or HbA1C of 6.5% or greater. Incident dementia was ascertained via active surveillance involving interviews and adjudication. We conducted survival analysis using age as the time scale with age 50 as the origin and December 31st, 2019 as the administrative censoring date. Dementia risk was analyzed with death treated as a censoring event or as a competing risk. Results: Among 13,381 participants, 1798 (13.4%) had diabetes at baseline (mean age: 56.8 years). Using a standard Cox model, diabetes was associated with an increased hazard of dementia (HR 1.36; 95% CI 1.21, 1.52) and death (HR 1.87; 95% CI 1.76, 1.99). Censoring mortality (ignoring competing risk), diabetes was associated with a higher cumulative incidence of dementia at all ages ( Figure A ). Competing risk models showed a lower risk of dementia than models censoring death. Furthermore, diabetes was associated with a higher risk of dementia only before age 85 but a lower cumulative risk after age 85 due to the large excess risk of mortality ( Figures B and C ). Conclusion Standard methods dramatically overestimate the lifetime risk of dementia in persons with and without diabetes. Competing risk models are critical for accurate absolute risk estimates, particularly in the oldest ages. Interventions which increase life expectancy in patients with diabetes may increase the cumulative risk of dementia in old age.
Abstract MP03: Adiponectin Levels in Young Adulthood and the Association With Midlife Cognition: The Bogalusa Heart Study
Authors: Ileana De Anda-Duran, Owen Carmichael, Vijaya B Kolachalama, Camilo Fernandez, Rhoda Au, David Libon, Lydia A Bazzano
Journal: Circulation (2023)

Objective: Adiponectin (ApN), has anti-inflammatory and anti-atherogenic properties. Low levels of ApN are found even after normalization of glucose in patients with diabetes, and are implicated in atherosclerosis, and dementia onset but results vary across the lifespan. We assessed the relation of ApN levels in young adulthood, with midlife atherosclerosis, measured by carotid intima media thickness (cIMT), and with cognitive function among Black and White individuals from the Bogalusa Heart Study (BHS). Methods: A total of 604 participants from the BHS, a community cohort in rural Louisiana, were examined for ApN levels with lowest quartile of ApN levels (&lt;5.4 μg/mL) defined as low-ApN. Structural equation models assessed mediation via the temporal association of low-ApN (age 36±4) with midlife (age 49±5) cIMT, dichotomized above the 50 th percentile (&gt;0.88mm), and a global cognitive score(GCS) standardized for age, race and sex. Adjusted models included education attendance. Results: Individuals with low-ApN were more likely men [ 56.2% (77), p&lt;0.001] and White [54.7% (75), p&lt;0.001]. No differences in education were found. There was a direct association between low-ApN and GCS (P=0.025), low-ApN and cIMT ≥ 50 th (P=0.001), and cIMT ≥ 50 th and GCS (P=0.002). ( Figure1) In mediation analysis, the ratio of Indirect effect/Total effect was 0.108, indicating that ~11% of the effect of low-ApN on GCS was mediated by cIMT. Education was not associated with low-ApN. Conclusion: Low-ApN levels in early adulthood was associated with poor cognition after ~10 years of follow-up, and the association was partially mediated by subclinical atherosclerosis. This suggests that ApN may play a role in neurodegeneration mechanisms and contribute to the development of dementia, underscoring the importance of addressing cardiometabolic influences earlier in the lifespan to prevent/delay cognitive decline.
Abstract P510: Increase in Obesity Reduction Initiatives in San Francisco After Sugary Beverages Tax Implementation
Authors: Allison Voorhees, Galina Inzhakova, Monique Hedderson, Jennifer Falbe, Deborah R Young
Journal: Circulation (2023)

A diet high in sugar sweetened beverages (SSB, has been shown to be associated with adverse health outcomes. Several cities across the US have implemented SSB taxes to decrease consumption and distribution of sugary drinks. Revenues generated from taxes were often allocated to fund public health programs and enhancements to reduce obesity. We examined efforts in San Francisco where the Sugary Drinks Distributor Tax (SDDT or “soda tax”) was implemented in 2018. SDDT legislation mandated the establishment of the Sugary Drinks Distributor Tax Advisory Committee (SDDTAC), responsible for making annual recommendations for the allocation of tax-generated revenues. We reviewed SDDTAC recommendations and funding for new and existing services that support public health through reduction and prevention of diet related diseases. We assessed if there was a significant increase in funding and number of health promotion programs implemented in San Francisco after the implementation of the SDDT. We documented obesity prevention initiatives resulting from increased tax revenue. We reviewed city government budget documents and press releases at least 1 year before tax implementation (2017) and 4 years post (2018-2022). We cataloged initiatives for adults and children including health education, nutrition and lifestyle, and community projects. The first full year of SDDT implementation (2018-19) saw the highest revenue generated at $16,097,908. Total revenue for the implementation period (2018-2021) was reported as $42,415,548. The revenue generated in the first six months of fiscal year (FY) 2018 was spent in FY2019-2020. During that period, the San Francisco Public Health Foundation awarded 26 one-year SDDT community grants - aligning with priority expenditure categories for SDDTAC - totaling $1,702,211. SDDTAC priority categories include decreasing consumption of sugary drinks, increasing water consumption, oral health, healthy food access, physical activity, and other (e.g. research/Community-Based Participatory Research, new innovations, etc.). [ACV1] In FY2019-2020 78% of SDDT revenues were spent on Healthy Communities, oral health, Healthy Food Purchasing Supplement grants and SF City Funded Agencies’ programming. The remaining 22% were spent on social media grants, infrastructure, and administrative costs. To address COVID-19, $1.65 million of unused funds from FY2019-20 supported food security and food distribution for vulnerable populations. Tax generated funding for 65 new or existing programs since implementation. New programs are funded each year: five new Policy Systems and Environmental Change programs were funded in FY2019-2020 and one new school-based program funded in FY2021-22. We observed a significant increase in number of health programs in San Francisco since SDDT implementation.
Abstract P351: Prevalence of Diabetes in a Sub-Saharan African Community
Authors: Daouda Niassy, Ibrahima Bara Diop, Audrey Geoffroy, Awa Ba, Mor Diaw, Mame Awa Sene, Gabriel S Tajeu, Abdoulaye SAMB, Sidy Mohamed Seck, Xavier Jouven, Bamba Gaye
Journal: Circulation (2023)

Background: Diabetes is a major cardiovascular disease (CVD) risk factor. There has been a epidemiological shift and chronic CVD is increasing in Sub-Saharan Africa, however, the extent is unknown. Methods: Data were collected between March and April 2013 from 3 regions of the Northern Senegal (i.e., Saint-Louis, Matam etand Louga) using a cluster sampling method and the survey base of the national statistical and demographical agency, we included subjects aged between 18 and 80 years old. Participants underwent a face-to-face questionnaire to collect demographics and data on cardiovascular history/risk factors. Blood pressure and anthropometric measurements were measured in addition to blood tests including fasting plasma glucose. Diabetes was defined as fasting plasma glucose &gt;= 1.26 g/L. Continuous data were reported as mean ± standard deviation (SD). Comparisons used the chi-squared test for categorical variables and Student’s t test for continuous variables. Multivariable adjusted logistic regression was used to identify factors associated with diabetes. Covariates with significant association (P&lt;0.05) in univariate analysis were included in the model. Results: Among the 2440 subjects in this study (mean age: 44 years old, SD: 15.99), 692 (28%) were male. Nearly half of the sample never attended school (48%, 95%CI: 46-50%). Body mass index (BMI) higher than 25 was present in 43% of the sample (95%CI: 29-35%), with a significant increase in women (51% vs 22%, p&lt;0,001).. The prevalence of diabetes was 5.9% (95%CI: 5-6,9%). Among them, 93% had at least two cardiovascular diseases (95% CI: 87-96%), 71% had dyslipidemia (95%CI: 63-78%) and 67% had a BMI over 25 (95%CI: 58-74%). Conclusion: This community-based study revealed a low prevalence of diabetes. However, the prevalence of additional CVD risk factors in this population was high. Preventive measures should be implemented to avoid increasing rates of diabetes in Sub-Saharan Africa.
Abstract P106: Prevalence of Cardiometabolic Risk Factors in Patients With versus Without Cancer: Insights From a Large US Healthcare System
Authors: Izza Shahid, Aayush Shah, Rakesh Gullapelli, Eleonora Avenatti, Jorge Carrasco Avila, Roshni Mandania, Nihan Farooq, Sherif F Nagueh, Maan Malahfji, Jenny Chang, Khurram Nasir
Journal: Circulation (2023)

Background: Although cardiometabolic dysfunction is associated with an increased risk of cancer, the prevalence of cardiometabolic risk factors in patients with and without cancer remains less well-established. Therefore, we aimed to examine the prevalence and association of cardiometabolic risk factors in patients with versus without cancer who do not have established atherosclerotic cardiovascular disease (ASCVD). Methods: Data of ∼1.1 million patients aged 18+ years in the Houston Methodist Learning Health System Outpatient Registry was utilized to identify patients with and without cancer with cardiometabolic risk factors including hyperlipidemia, diabetes mellitus (DM), obesity and hypertension using the ICD-10 codes. Patients with prevalent ASCVD were excluded. Age-adjusted prevalence of cardiometabolic risk factors was calculated and multivariate logistic regression models were utilized to determine the association between cardiometabolic factors and risk of cancer. Results: A total of 76,312 (7.8%) patients with cancer and 897,408 (92.2%) patients without cancer were included. Compared with patients without cancer, patients with cancer had increased age-adjusted prevalence of hypertension (38.4% vs 33.4%), obesity (30.7% vs 29.6%), hyperlipidemia (26.0% vs 22.0%) and DM (13.9% vs 11.0%). Compared with patients without cancer, patients with cancer had significantly increased odds of hyperlipidemia (OR 1.32 [1.30, 1.34]), hypertension (OR 1.82 [1.79, 1.85]) and DM (OR 1.42 [1.39, 1.45]). Conversely, obese patients were less likely to have cancer (OR 0.96 [0.95, 0.98]) compared with patients without cancer. Conclusion: Amongst patients without established ASCVD, increased prevalence of cardiometabolic risk factors is observed in patients with cancer versus without cancer. Strategies optimizing cardiometabolic health such as routine screening, monitoring, evaluation, and management of these factors should be prioritized to curtail adverse cardiovascular and cancer outcomes.
Abstract P464: A 5-Day Lifestyle Program for Tobacco and Paan Cessation in South India
Authors: SAMUEL G HANSDAK
Journal: Circulation (2023)

Tobacco is a leading global preventable cause of premature death accounting for over 8 million deaths amongst its 1.3 billion users and costing the global economy US$ 1.4 trillion each year. In India, 29% of all adults are users with the most prevalent form being smokeless tobacco. It’s use is the #3 attributable risk factor for death in India accounting for nearly 1.35 million deaths annually. Areca (Betel) nut is consumed by 24% of adults with significant oral &amp; other health consequences. Greater attention needs to be given to preventing initiation and cessation of tobacco, nicotine and areca nut products. This study aimed to assess the response of patients attending to a 5-day tobacco and paan cessation program in a dental clinic of a South India teaching hospital from May 25 to December 25, 2019. All patients attending a dental clinic were screened for tobacco and/or paan use. If present, they were invited to attend a 5-day “Living Free from Tobacco &amp; Paan” program which did not use pharmacologic aids. Nicotine tests are offered to those completing the program. Telephonic follow-up was conducted to ascertain and encourage sustained abstinence. 85 of 179 patients completed 5 days of which 78.8% had a negative nicotine test. Tobacco product users included: smokeless (44%), smoker (31%) and both (26%). About ½ users had low, 1/4 moderate and 20% severe dependence. Most common oral cavity lesions were tobacco pouch keratosis, leukoplakia, and oral submucous fibrosis. This program was well received and has a very acceptable early quit rate. Additional patient follow-up is needed to ascertain sustained abstinence. Intentional habit cessation interventions should be offered by all healthcare providers.